Rights as a Health Insurance Consumer

If you purchased insurance coverage from a licensed insurer, you have the benefit of many important protections.

COBRA Continuation Coverage
If you purchase insurance coverage through your employer and your employer has 20 or more employees, you are entitled to continuation coverage by the federal Consolidated Omnibus Budget Reconciliation Act (COBRA).

Our state has a mandatory continuation of coverage privilege. The law provides that an employee or member who has been insured under the group policy for at least six months and who loses coverage for any reason (other than non-payment of premium) may continue coverage for the fractional policy month remaining plus six months.

Under COBRA, if you leave your current job, you have the option to continue your health care coverage for up to 18 months. You are required to pay the full premium yourself, even if your employer paid part of your premium while you were employed, and the employer may charge an additional, limited administrative fee. You can find out more about COBRA continuation of group health benefits from the Federal Department of Labor Office of Employee Benefits Security Administration website.
Eligible Individual Criteria
To be an "eligible individual," you must meet all of the following criteria:

You must have had 18 months of continuous creditable coverage, with at least the last day having been under a group health policy (coverage is considered continuous if it is not interrupted by a break of 63 or more consecutive days).

You must have used up any COBRA group continuation coverage for which you were eligible. See the above section for information on COBRA.

You must not be eligible for Medicare, Medicaid, or a group health policy.

You must not have other major medical health insurance.

You must apply for health insurance for which you are deemed an “eligible individual” within 63 days of losing your prior coverage.

Groups of less than 20 employee's (State Continuation Brochure)

Our state has a mandatory continuation of coverage privilege. The law provides that an employee or member who has been insured under the group policy for at least six months and who loses coverage for any reason (other than non-payment of premium) may continue coverage for the fractional policy month remaining plus six months.